<!--
To change this template, choose Tools | Templates
and open the template in the editor.
-->
<!DOCTYPE html>
<html>
    <head>
        <title></title>
        <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
        <link type="text/css" rel="stylesheet" href="css/form.css"/>
    </head>
    <body>
  <form class="jotform-form" action="http://submit.jotformz.com/submit/23337306045649/" method="post" name="form_23337306045649" id="23337306045649" accept-charset="utf-8">
  <input type="hidden" name="formID" value="23337306045649" />
   <div class="form-all">
        <ul class="form-section" >
      <li class="form-line" id="id_38">
        <label class="form-label-top" id="label_38" for="input_38">
          20- Nas ultimas quatro semana o quanto você tem se angustiado ou preocupado:<span class="form-required">*</span>
        </label>
        <div id="cid_38" class="form-input-wide">
          <table summary="" cellpadding="4" cellspacing="0" class="form-matrix-table">
            <tr>
              <th style="border:none">
                &nbsp;
              </th>
              <th class="form-matrix-column-headers" style="width:22%">
                Nem um pouco
              </th>
              <th class="form-matrix-column-headers" style="width:22%">
                Um pouco
              </th>
              <th class="form-matrix-column-headers" style="width:22%">
                Moderadamente
              </th>
              <th class="form-matrix-column-headers" style="width:22%">
                Muito
              </th>
              <th class="form-matrix-column-headers" style="width:22%">
                Extremamente
              </th>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                a- Por sentir dores de Cabeça
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[0]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[0]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[0]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[0]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[0]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                b - Pela perda de interesse ou Prazer Sexual
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[1]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[1]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[1]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[1]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[1]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                c - Por ter Fraqueza ou Tontura
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[2]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[2]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[2]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[2]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[2]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                d - Por Sentir Dor Ou aperto no Peito ou no Coração
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[3]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[3]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[3]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[3]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[3]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                e - Pela Sensação de Falta de Energia ou Lentidão
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[4]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[4]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[4]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[4]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[4]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                f - Por Ter Pensamentos Sobre Morte ou Relacionado ao Ato de Morrer
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[5]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[5]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[5]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[5]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[5]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                g - Por Ter Falta de Apetite
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[6]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[6]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[6]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[6]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[6]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                h - Por Chorar Facilmente
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[7]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[7]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[7]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[7]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[7]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                i - Por se culpa pelas coisas que acontecem ao redor
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[8]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[8]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[8]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[8]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[8]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                j - Por Sentir dor na parte inferior das costas
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[9]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[9]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[9]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[9]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[9]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                k -Por se sentir só
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[10]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[10]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[10]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[10]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[10]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                l - Por se sentir Triste
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[11]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[11]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[11]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[11]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[11]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                m - Por se preocupar muito com as coisas
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[12]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[12]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[12]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[12]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[12]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                n - Por não ter interesse pelas coisas
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[13]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[13]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[13]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[13]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[13]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                o - Por ter enjoos ou problemas no estômago
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[14]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[14]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[14]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[14]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[14]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                p - Por ter Músculos Doloridos
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[15]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[15]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[15]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[15]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[15]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                q - Por ter dificuldade em Adormecer
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[16]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[16]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[16]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[16]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[16]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                r - Por ter dificuldade em Respirar
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[17]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[17]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[17]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[17]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[17]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                s - Por sentir de vez em quando calor ou frio
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[18]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[18]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[18]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[18]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[18]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                t - Por sentir dormência ou formigamento em partes do corpo
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[19]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[19]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[19]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[19]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[19]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                u - Por sentir um nó na garganta
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[20]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[20]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[20]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[20]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[20]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                v - Por se sentir desanimado sobre o futuro
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[21]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[21]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[21]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[21]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[21]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                w - Por se sentir fraco em partes do corpo
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[22]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[22]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[22]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[22]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[22]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                x - Pela sensação de peso nos braços ou pernas
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[23]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[23]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[23]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[23]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[23]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                y - Por ter pensamentos sobre acabar com sua vida
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[24]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[24]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[24]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[24]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[24]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                z - Por comer demais
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[25]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[25]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[25]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[25]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[25]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                aa - Por acordar de madrugada
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[26]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[26]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[26]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[26]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[26]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                bb - Por ter sono agitado ou pertubado
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[27]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[27]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[27]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[27]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[27]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                cc - Pela sensação de que tudo é esforço ou sacrificio
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[28]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[28]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[28]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[28]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[28]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                dd - Por se sentir inultil
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[29]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[29]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[29]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[29]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[29]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                ee - Pela sensação de ser enganado ou iludido
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[30]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[30]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[30]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[30]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[30]" value="Extremamente					" />
              </td>
            </tr>
            <tr>
              <th align="left" class="form-matrix-row-headers" nowrap="nowrap">
                ff -Por ter sentimentos de culpa
              </th>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[31]" value="Nem um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[31]" value="Um pouco" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[31]" value="Moderadamente" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[31]" value="Muito" />
              </td>
              <td align="center" class="form-matrix-values">
                <input class="form-radio validate[required]" type="radio" name="q38_20Nas38[31]" value="Extremamente					" />
              </td>
            </tr>
          </table>
        </div>
      </li>
      <li id="cid_59" class="form-input-wide">
        <div class="form-pagebreak">
          <div class="form-pagebreak-back-container form-label-left">
            <button type="button" class="form-pagebreak-back  form-submit-button-book_blue1" id="form-pagebreak-back_59">
              Voltar
            </button>
          </div>
          <div class="form-pagebreak-next-container">
            <button type="button" class="form-pagebreak-next  form-submit-button-book_blue1" id="form-pagebreak-next_59">
              Próximo
            </button>
          </div>
        </div>
      </li>
    </ul>
   </div>
  </form>
    </body>
</html>